S Africa's healthcare challenges

South Africa's healthcare system, underfunded and overwhelmed, is in crisis.

It caters to the biggest HIV-positive population in the world and offers poor healthcare services for mothers and children who cannot afford private medical treatment.

For many of the country's poorest, there are few options.

Al Jazeera's Haru Mutasa looks at South Africa's ailing healthcare system and government initiatives to quickly provide care to the most in need.

A number of women and their children have been standing in long queues at a waiting room in Pretoria, the capital of South Africa, hoping to take advantage of a free immunisation programme launched by the United Nations Children's Fund (Unicef).

The UN, which says almost 10 per cent of South Africa's children are underweight, is hoping to reach three million children under the age of five through this campaign.

For the next two weeks, South Africa's poorest children will receive vitamin supplements, de-worming pills and immunisation injections for free in public medical facilities across the country.

Most South Africans cannot afford private healthcare and turn to the state for help

Under apartheid all the best medical care was reserved for the white minority. Even though healthcare for black South Africans has improved – conditions in public hospitals remain basic.

Gladys Shiabambo, who has brought her one-year-old son to be immunised, is unemployed and cannot afford private medical care. She says conditions in some government hospitals are "terrible".

"It is not healthy to see what is happening at the public hospitals," she says.

"It's not a place when you are sick you would want to go to. You think I should just die at home instead of dying there. Because you know when you are really really sick you are going to die there, you really going to die."

High levels of poverty and unemployment means the healthcare burden largely falls on the state. A third of South Africa's population live in abject poverty and most live in poor communities where sometimes putting food on the table can be a challenge.

Private medical treatment

But bigger hospitals where specialist treatment or admission is required demand cash for treatment.

Chris Hani Baragwanath Hospital caters to almost four million people in the Soweto township and is just one of many public hospitals struggling to care for its 3,000 patients.

In addition to ageing facilities, which are in need of repair or replacement, the country's HIV/Aids epidemic - the largest in the world – has put enormous strain on the overwhelmed and underfunded public hospitals and the fragile healthcare system at large.

An eighth of the population is HIV positive.

South Africa spends more on healthcare than any other African country – 8.7 per cent of its GDP according to World Bank figures from the World Development Indicators 2008.

Low wages

Problems in the healthcare industry are further compounded by the fact that medical professionals are leaving the public sector because of low wages.

The South African Medical Association's report in 2008 said doctors in the public sector were underpaid by up to 200 per cent compared with their counterparts in the private sector.

The government has built more than 1,300 clinics since apartheid ended in 1994

Private doctors in South Africa take home almost $2000 more than doctors in the public sector.

That means hospital wards have too many patients and not enough nurses.

"This is a medical ward as you can see it's got 69 beds and as we speak there are 62 patients and there are nine nurses," says Johanna More, the acting CEO of Baragwanath Hospital.

"So you can imagine the ratio is very challenging for the nurses so the care is compromised because of the load of patients."

Patients at this hospital pay between $5 and $40 for treatment. Some say they understand the pressure that government nurses are facing.

"They are trying their utmost best," says patient Stalin Mchunu.

" I don't blame them – I can't put every blame on the government ... they are trying their best, but it's beyond their means."

Government efforts

Since 1994 more than 1300 clinics have been built or upgraded by the government.

South Africa is also importing doctors from Tunisia, Cuba, Iran and the Southern Africa region to stem the brain drain.

Officials are also trying to introduce affordable quality universal healthcare. National Health Insurance has been planned – but it could be months before it is implemented; the government says it is looking at April next year as a tentative roll-out date.

The idea behind the National Health Insurance, according to the African National Congress party, is not only to address the needs of the 40 million uninsured, but also millions who are currently insured or under-insured by existing medical schemes.

Private medical cover in South Africa can cost anything between $1,500 and $10,000 - too expensive for millions across the country.

For the meantime, mothers like Gladys Shiabambo will continue to queue up for free medical treatment.